Information Collection

Occupational Data for Health (ODH) Prototype usability testing

IC 237926 under ICR 201802-0920-007 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
footer.png	Other-Footer
header.png	Other-header
0920-0953 PRE-TEST DEMOGRAPHIC DATA SURVEY FOR OCCUPATIONAL DATA F Attachment A- Pretest.docx	Form
0920-0953 POST-TEST SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH) Attachment B- Post-test.docx	Form
0920-0953 Occupational Data for Health (OHD) Phototype Version 3 Summary screen.JPG	Form and Instruction
0920-0953 Employment Status & Retirement dates Employment Status & retirement dates.JPG	Form
0920-0953 Longest Held Occupation Longest Held Occupation.JPG	Form
0920-0953 Work History Work History.JPG	Form
NIOSH GenIC- ODH Prototype usability testing.docx Request for Approval	IC Document

IC Title:

Occupational Data for Health (ODH) Prototype usability testing

Agency IC Tracking Number:

0920-0953-19BNK

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-header			header.png	Yes	No	Printable Only
Form and Instruction	0920-0953	Occupational Data for Health (OHD) Phototype Version 3	Summary screen.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	Employment Status & Retirement dates	Employment Status & retirement dates.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	Longest Held Occupation	Longest Held Occupation.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	Work History	Work History.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	PRE-TEST DEMOGRAPHIC DATA SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH) PROTOTYPE USABILITY TESTING	Attachment A- Pretest.docx	Yes	Yes	Fillable Fileable
Form	0920-0953	POST-TEST SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH)	Attachment B- Post-test.docx	Yes	Yes	Fillable Fileable
Other-Footer			footer.png	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	NIOSH GenIC- ODH Prototype usability testing.docx	09/30/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.